670590.pdfBUILUINU utrAKIMCHI I ApplicantlFill
PERMIT APPLICATION Llside Heavy Lines
NAM (OR NAME OF BUSINESS)
CITY OF EDMONDS
MAILINGADDRESS
CITY 250 - 5th Avenue North TELEPHON!
Edmonds, Washington Pr. 6-
gal Description of Property (Show Below or Attacn ifour uQV&c-;
Lot #14 - Bic& #6 of Oscar E. Jensen
NEW
RESIDENTLILL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
0 ALTER
'EXCAVATE
OR PILL
PENCE
( x .......... Ft.)
.........
REPAIR
El
PRE -MOVE
INSP.
SWIM
POOL
I NUMBER OF
DWELLING
UNITS
- 190th S.W
Y
PERMIT
NUMBER
67059/0
YEE; 13 NO
��S;&G'STREET R/W .......... FT. DEFICIENCY TBIS PROPERTY
comp. PLAN ST. R/W .... ...... XT. .......... FT.
0 YES [3 NO
REMARKS
OF
Demolish
Plan Check No ............... . ...
PROPOSED USE
BUILDING
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
HEAT & GAS LINE
FENCE
t
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author -
lead agent of the owner. I agree to comply with city and state, laws rOgu-
ATTENTI[ON
lating construction; and in doint the work authorized thereby, no person
will be employed In violation Of the Labor Code of the State of Washington
TIUS PEBMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Umit One Year (Except DE31OUTIONS which
WORK NOTED
shall be completed in ninety days; MOVED -IN BUILDINGS shall be OOm-
plated In nix months.)
SIGNATURE (OW14=" OL" AGENT)
DATE SIGNED
IN13PECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Pwrmlt covers work to be done on Piriv a property ONLY.
Any constroctlon an the public domain (eurbal sidewalkso drivownYov
marquees, etc.) will require separate permission.
Valuation
E3 YES E3 NO
Fee
0
ow
APPLICATION APPROVAL
No.
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged In space provided.
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